Measuring and Correcting the Atlas/Axis Complex

An Exciting New Role for the Massage Therapist

By John D. Barrera RMT CNMT MTI


The purpose of this article is to empower the Massage Therapist (MT) to learn more about the fascinating C1/C2 region of the cervical spine.

C1/C2 displacements can have far reaching implications on both the anatomy and physiology. Literally billions of neurons traverse this region providing essential, life sustaining information to the entire body.
Compromised fluctuations in normal blood flow by way of vertebral artery occlusion due to C1 mal-position may contribute to vascular type headaches, dizziness as well as pressure related injury (stroke).
A myriad of pain patterns with bizarre phenomena are possible with C1/C2 vertebral mal-position due to increased joint pressure and undue influence on the cranial nerves.
The measurement and correction of upper cervical spine subluxation complexes i.e. C1 and C2 vertebra is essential if long term relief is to be attained.
This article will also help the MT better understand his or her role and ability to treat the cervical spine.
The MT will also learn the importance of working well within his or her scope of practice i.e.; soft tissue treatment, corrective stretching and corrective movement therapy.

Scope of Practice

We are not “adjusting” the spine as our friends in the Osteopathic and Chiropractic professions are licensed to do. With this new understanding, the Massage Therapist is likely to develop solid referral networks with other allied healthcare professionals.
Further, this writing can help the MT realize his or her powerful role and ability to positively influence the cervical spine via specific soft tissue manipulation and active/passive stretching. This new field of pain relief and pain management is multifaceted.

Today’s Massage Therapist must be well versed in neurology, physiology and functional anatomy. This new role will vary widely depending on the level of training and work experience.

A therapist desiring a career in a rehabilitation setting should seek advanced level clinical courses and insist on working in clinical/medical settings. This placement is likely to provide the exposure necessary for a successful clinical/medical massage therapy career.


Atlas/Axis adjustment techniques have been around since the early 1900’s in the form of Chiropractic manipulation. Chiropractic originators such as DD Palmer and his son BJ Palmer realized that cervical vertebra displacement at any level could and usually did play a major role in body pain syndromes.

Unfortunately, little if anything was known about the connective tissues that encapsulate, stabilize and maintain these joints. With the exception of Dr. Raymond Nimmo’s receptor tonus work, strategic massage technique and specific muscle stretching designed to target the soft tissue component of cervical imbalance were mostly non-existent.

Grostic Chiropractic made its debut in the 1960’s. This form of upper cervical manipulation specifically targeted the upper two cervical vertebras. Interestingly, the late Dr John Grostic was a Palmer College graduate. Dr. Grostic used high velocity low amplitude (HVLA) Chiropractic techniques to “adjust” C1 and C2 vertebral subluxation. This particular approach if indicated, usually offered instantaneous relief in the form of a decrease in proprioceptive joint pressure.

Unfortunately, the relief was usually short lived as neurological energy in the form of muscle tonus would re-establish the joint pressure instantaneously relieved by the adjustment. Generally speaking this approach is very effective in the short run but needed additional support to attain longer lasting relief. Form versus Function To be effective in this simple but complex area the MT must more thoroughly understand the role of

Form vs. Function

Wolf’s Law of Bone Transformation states “every change in the form and the foundation of a bone, or in its function alone, is followed by certain definite changes in its internal architecture and secondary alterations in its external conformation.”

A muscle’s primary mandate is movement and a bone’s primary mandate is one of structural support. This law basically tells us that form and function are inseparable. The loss of cervical curvature is a change in the function of the structure that can result in “certain definite changes” in the form of the bone.

When the loss of cervical curvature has occurred usually as a result of trauma, we see vertebral body remodeling take place i.e. spurs, lipping of end plates, degenerative disc disease and arthritic changes. A functional/mechanical stenosis may also occur at the dural tube level as internal ligaments are tensioned due to vertebral body position. Many mysterious symptoms come to be when a loss of cervical curve is present.

Muscles and ligaments help determine exactly where the C1 vertebra will come to rest on its articular facets. The superior and inferior articular facets that exist between C1/Occiput and between C1/C2 allow for great movement within this region. These joints create a majority of the cervical spine’s ability to rock, tilt, flex and extend. The articular facets between C1 and C2 and C1 and Occiput allow the C1 vertebra to essentially float in place.

These joints are saucer-like and glide easily upon one another especially if lax ligaments exist. Pressure from the loss of cervical curvature and or the hyper-contraction of certain musculature can cause the vertebra to displace and or shift. Relatively speaking, and for the purpose of this discussion; there are two distinct types of movement; functional and dysfunctional.

Functional movement may be defined as the joints normal inherent movement capability.  This includes but is not limited to movements within the joint complex that allow flexion, extension, lateral movements, circumduction, etc.. These movements are attainable provided the joint is healthy and free from soft tissue hyper-contraction and dysfunction (joint pathology). Generally speaking, a moveable spine is a healthy spine.

Dysfunction and Movement

Dysfunctional Movement (DM) may be defined as aberrant movement patterns that include hyper and hypo-mobility and or a position in space that may have resulted from habitual patterns and or trauma. DM is created by work and play habits, accidents, hereditary factors and other activities of daily living.

A system of categorization has been created by the author to measure and quantify the degree of movement within the C1/C2 complex that is thought to be pathological. Potential imbalances can be documented as Lateral Shearing (Atlas) Rotation (C1/C2) Projection (C1) and Tilt dimensions. These imbalances may also exist in combinations. An example of this is an Atlas that is in both a rotated and tilted position in space relative to known landmarks.

The potential for healthy movement usually turns to dysfunction with the imposition of violent acceleration/deceleration forces similar to those experienced commonly in car crashes. These forces act to undermine the integrity and stability of the capsular ligaments and muscles thus leading to hyper- and hypomobility and positional displacement.
Additionally, muscle pathologies such as ischemic contraction and Trigger Points further the potential for imbalance. Once a joint is hyper or hypo-mobile, its position in space, especially the atlas, becomes secondary to muscular tension, habitual postural patterns and activity.


Upper cervical vertebra displacements usually go undiagnosed, causing a myriad of seemingly mysterious negative symptoms. The measurements and evaluation process set forth in this course of study will greatly aid the MT in determining C1/C2 position.

Measurements can be taken using known landmarks as points of reference. One particular point of reference is the mastoid processes of the temporal bone. These bony protuberances are located directly above the lateral processes of the Atlas. Using them as reference point, it can be determined whether the atlas is in a normal or pathological position.


The resultant pain due to mal-position of the C1 and C2 vertebra is largely due to the increase in proprioceptive pressure within the joint, compression of spinal and cranial nerves and alterations in structural blood flow to the brain due to changes in the cervical architecture.

Deep internal facial pulls may also exist and can create a myriad of symptoms. The dural tube is anchored at C2 and around the foramen magnum usually suffers unnecessary connective tissue pulls that compromise health. This deep internal dural tube pulling will affect vertebral bone position.

Muscular imbalance due to trauma will likely result in abnormal muscle pull (imbalance) and other dysfunctions of the connective tissue thus leading to Atlas/Axis mal-position.


A qualified MT has a distinct advantage regarding this area in that he or she can not only perform appropriate soft tissue techniques but and also apply specific Atlas/Axis corrective stretching techniques that can potentially provide long term, pressure relieving positional balance.

Leveraging, blocking (inhibition) and capturing a vertebra, so that the soft tissues that reside above and below it are stretched are well within an MT’s scope of practice. The addition an active phase movement to this stretch allows the MT to utilize the client’s muscle recruitment ability to further enhance the stretching strategy.

The Future

Atlas/Axis balancing from a soft tissue perspective is in its infancy. Research in the form of hands-on therapy and by trial and error was performed that fostered the development of the technique known today. Formal research has not been conducted in the Massage Therapy field.

Clinical Massage Therapists in the USA have had great success with their soft tissue approach to headache situations. It is widely known that the specific release of ischemic muscle hyper-contractions and Trigger points is effective for a myriad of pain syndromes. This work takes Massage Therapy to the next level. The Atlas/Axis treatment flow charts are an integral part of healing this vital region of the body. The charts memorialize the potential for both balance and imbalance.

A Massage Therapist in our opinion needs to know how to measure and determine whether or not vertebral mal-position is responsible for the pain a client may posses. Once this information is understood, correction the imbalance is quite easy in most cases.

A manual therapist must also realize the importance of not only the preparatory benefits of clinical massage but also its role in the long term stabilization of the C1/C2 complex. This new field of massage treatment targets one of the root causes of cervicogenic pain.

By balancing the area between the Atlas and Axis and the area between the Atlas and the occiput, pressure is lifted from vital cranial nerves and blood vessels that reside in the area. The restoration of the cervical curve allows blood flow to the brain to normalize as well as the minimization of mechanical structural stenosis. Pressure is also relieved from the dural tube via the C2 and foramen magnum attachments.

John D. Barrera

John D. Barrera is a clinical Massage Therapist and International presenter with over 22 years of active medical/clinical massage experience.

He has spent the last six years furthering the development of Atlas/Axis/ Cranial Base balancing for the Massage Therapist.

John has authored two measurement and treatment strategy flow charts that will further the understanding of the Massage Therapist and other allied health professional in this emerging and fascinating field of study.

The Atlas/Axis/Cranial Base Connection could be an answer to relentless head, neck and body pain.